急性蛛網(wǎng)膜下腔出血及高血壓患者血漿腦鈉素水平改變對左心室功能的影響

摘要： 目的檢測急性蛛網(wǎng)膜下腔出血(SAH)患者血漿腦鈉素(BNP)水平,超聲心動圖方法觀察患者心臟左心室功能(LVF)的改變并探討其機(jī)制,為防治急性SAH所致心臟損害提供依據(jù)。方法急性SAH組42例為發(fā)病24小時之內(nèi)的急性SAH患者;高血壓組30例,收縮壓和舒張壓均分別大于140mmHg與90mmHg,且除外心功能不全、心律失常等心臟并發(fā)癥,無肝腎疾病史;正常對照組為來體檢健康人;均行超聲心動圖檢查,同時檢測血漿BNP并對結(jié)果進(jìn)行分析。結(jié)果急性SAH組患者的左室舒張末期內(nèi)徑、左室后壁厚度、室間隔厚度、相對室壁厚度、左室心肌重量、左室心肌重量指數(shù)均值與正常對照組比較差異無顯著性。急性SAH組每搏輸出量、每分心輸出量及心臟指數(shù)均值低于正常對照組。急性SAH組左室射血分?jǐn)?shù)均值明顯低于正常對照組。急性SAH組E峰最大速度/A峰最大速度比值均值顯著低于正常對照組。急性SAH組血漿BNP濃度高于正常對照組。結(jié)論急性SAH發(fā)病后血漿BNP濃度升高,并伴有左心室收縮功能和舒張功能下降;可能與急性SAH本身的病理生理機(jī)制有關(guān)。
Objective To observe the changes of left ventricular function in patients with subarachnoid hemorrhage (SAH) and the correlation with plasma brain natriuretic peptide (BNP) by using echocardiography and determining plasma BNP concentration,and to approach the mechanism and find the evidences for preventing and treating cardiac impairment caused by SAH.Methods 42 patients with SAH within 24 hours diagnosed by clinical manifestation and head computed tomography were selected.All enrolled patients had no history of heart diseases and no complications such as cardiac insufficiency and arrhythmia.And in the same period thirty sex and age matched hypertension patients and thirty sex and age matched healthy persons were enrolled as control groups.All patients and controls were undergone echocardiographic investigation and in the same time blood was drawn for the quantitative determination of plasma BNP concentration.Results There was no significant difference in the mean of end-diastolic left ventricular internal dimension (LVIDd),left ventricular end-diastolic posterior wall (LVPWT),end-diastolic interventricular thickness (IVST),relative wall thickness (RWT),left ventricular mass (LVM),left ventricular mass index (LVMi) between SAH group and control group.The mean of stroke volume (SV),the mean of cardiac output (CO) and the mean of cardiac index (CI) in SAH group were lower than those in control group respectively.The mean of LVEF in acute SAH group was much lower than that in control group.The mean of E/A ratio in acute SAH group was much lower than that in control group.The plasma BNP concentration in SAH group was higher than that in control group.Conclusion SAH can cause left ventricular systolic function to decrease and may cause left ventricular diastolic function to decrease.The plasma BNP concentration increases after the onset of SAH.The rise of plasma BNP concentration may be caused by the pathophysiologic mechanism of SAH.